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Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as impotence, although this term is now used less often.
Occasional ED isn’t uncommon. Many people experience it during times of stress. Frequent ED, however, can be a sign of health problems that need treatment. It can also be a sign of emotional or relationship difficulties that you may want to address with a professional.
What causes an erection?
ED can occur because of problems at any stage of the erection process. An erection is the result of increased blood flow into your penis. Blood flow is usually stimulated by either sexual thoughts or direct contact with your penis.
When a person with a penis is sexually excited, a muscle within the blood vessels in the penis relaxes. This allows for increased blood flow through the penile arteries, filling two chambers inside the penis. As the chambers fill with blood, the penis grows rigid.
An erection ends when the muscles in the blood vessels contract and the accumulated blood can flow out through the penile veins.
According to the National Institute of Diabetes and Digestive and Kidney Diseases,
The prevalence of ED increases with age. The University of Wisconsin estimates that mild or moderate ED affects 10 percent more men for each decade of life. For example, 60 percent of men in their 60s might experience some form of ED.
However, ED can also occur among younger people. One 2013 study found that 1 in 4 men seeking their first treatment for ED was under 40 years old. Researchers observed a stronger correlation between smoking, drug use, and ED in these men when compared with older men. This suggests that lifestyle choices are an important factor for ED in younger men.
Although the risk of ED increases with age, ED isn’t inevitable. In general, the healthier you are, the better your sexual function. Learn more about aging and ED.
If you have diabetes, it’s important that you work with your doctor to manage your blood sugar levels. This can help to prevent damage that can lead to ED. Explore the connection between ED and type 2 diabetes.
There are many possible causes of ED, and they can include both emotional and physical conditions. Common causes include:
- cardiovascular disease
- hypertension, or high blood pressure
- high cholesterol
- low testosterone levels or other hormone imbalances
- kidney disease
- increased age
- relationship problems
- certain prescription medications, such as those used to treat high blood pressure or depression
- sleep disorders
- drug use
- consuming too much alcohol
- using tobacco products
- Parkinson’s disease
- multiple sclerosis (MS)
- damage to the pelvic area through injury or surgery
- Peyronie’s disease, which causes scar tissue to develop in the penis
ED can be caused by only one of these factors or by several of them. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions. Learn more about the causes of ED.
Testing for ED can involve a variety of steps, including a physical examination and examining your health and sexual history. Your doctor may order additional tests to determine if your symptoms are caused by an underlying condition.
Your doctor will ask you questions or request that you fill out a questionnaire about your symptoms, health history, and sexual history. The responses can help them evaluate the severity of your ED.
Some questions that they may ask include:
- How long have you been experiencing ED? Did it come on suddenly or gradually?
- Are you having any problems with feeling sexual desire, ejaculating, or reaching orgasm?
- How often do you have sex? Has this frequency changed recently?
- How firm are your erections? Is this affected by particular situations or types of stimulation?
- Do you wake up in the morning or in the middle of the night with erections?
- How’s your current relationship? What expectations do you and your partner have for each other? Have there been any changes?
- Have you recently been experiencing a lot of stress?
- What medications are you currently taking? Do you use tobacco, alcohol, or nonprescription drugs?
- Do you have any underlying conditions or have you had any surgery on or injury to your pelvic area?
Your doctor may perform additional testing to help diagnose your ED. Tests can include:
- Ultrasound. An ultrasound can be used to examine the blood vessels of the penis to determine if there’s a problem with penile blood flow.
- Nocturnal penile tumescence test. A portable, battery-powered device, worn on the thigh, is used to evaluate the quality of your nocturnal erections. The device stores data which your doctor can access later.
- Injection test. During this test, a medication is injected into your penis to stimulate an erection. This allows your doctor to evaluate the firmness of the erection and how long it lasts. This type of test can also be combined with ultrasound to further asses the erection.
- Urine tests. Urine tests can check for diabetes or other underlying health conditions.
- Blood tests. Blood tests can check for conditions such as diabetes, heart disease, thyroid issues, and low levels of testosterone.
These tests can help your doctor guide your treatment as well as determine if an underlying condition may be causing your ED. Find out more about how blood tests can help diagnose ED.
Treatment for ED will depend on the underlying cause. You may need to use a combination of treatments, including medication or talk therapy.
Your doctor may prescribe medication to help you manage the symptoms of ED. You may need to try several medications before you find one that works. The following oral medications stimulate blood flow to your penis to help treat ED:
Alprostadil (Caverject, Edex, MUSE) is another medication that can be used to treat ED. It can be administered in two ways: as a penile suppository, or as a self-injection at the base or side of the penis.
In most cases, however, alprostadil is not used alone as an injection, and the combination drug Trimix (alprostadil, phentolamine, papaverine) is used instead.
Your doctor may recommend testosterone replacement therapy (TRT) if you have low levels of testosterone.
Medications used for other conditions may cause ED. Talk with your doctor about your medications and whether they could be causing your symptoms. There may be others that you can take instead. Never stop taking medications without first talking with your doctor.
Medications for ED can cause side effects. If you’re experiencing unpleasant side effects, talk with your doctor. They may be able to recommend a different medication. Get more information on the medications used to treat ED.
A number of psychological factors can cause ED, including:
- post-traumatic stress disorder (PTSD)
If you’re experiencing psychological ED, you may benefit from talk therapy. Over several sessions, you and your therapist will discuss:
- major stress or anxiety factors
- your feelings around sex
- subconscious conflicts that could be affecting your sexual well-being
If ED is affecting your relationship, consider speaking with a relationship counselor as well. Relationship counseling can help you and your partner reconnect emotionally, which may also help your ED. Explore the effects of stress and anxiety on ED.
This treatment uses the creation of a vacuum to stimulate an erection. Using the device draws blood into the penis, leading to an erection.
A vacuum pump device consists of a few different components:
- a plastic tube, which you place over your penis
- a pump, which works to create the vacuum by drawing air out of the plastic tube
- an elastic ring, which you’ll move to the base of your penis as you remove the plastic tube
The elastic ring functions to maintain the erection, holding the blood in the penis and preventing it from returning to circulation. You can leave it in place for 30 minutes.
Trouble getting an erection and difficulty maintaining an erection during sexual activities are the most common symptoms of erectile dysfunction.
Other sexual disorders related to ED include:
- premature ejaculation
- delayed ejaculation
- anorgasmia, or the inability to achieve orgasm after ample stimulation
Speak with your doctor if you have any of these symptoms, especially if they’ve lasted for 3 or more months. They can help determine whether your symptoms are caused by an underlying condition that requires treatment.
Erectile dysfunction exercises
Certain exercises can also help with ED.
Kegel exercises are simple movements you can do to strengthen your pelvic floor muscles. Here’s how:
- Identify your pelvic floor muscles. To do this, stop peeing midstream. The muscles you use to do this are your pelvic floor muscles.
- Now that you know where these muscles are, contract them for 3 seconds. Then release them.
- Repeat this exercise 10 to 20 times in a row, three times per day.
Men in the first group saw their penile function improve significantly after 3 months of regular pelvic floor muscle exercises. Men in the second group saw little improvement after 3 months.
For the next 3 months, all participants were given at-home exercises to perform. After 6 months in total, 40 percent of all participants, including some men who had belonged to the second group, had regained normal erectile function.
A 2019 literature review also concluded that pelvic floor exercises were effective at treating both ED and premature ejaculation. However, the researchers didn’t identify an ideal exercise plan in terms of conditions such as frequency and intensity.
You may find that it’s easier initially to do Kegels while lying down. Eventually, you can start trying them when you’re sitting or standing.
Moderate to vigorous exercise is not only good for your overall health. It also can increase blood flow, possibly helping with ED. Examples include running and swimming.
A 2018 review of 10 studies examined the effect of aerobic exercise on ED. From their review, investigators concluded that 160 minutes of weekly exercise for 6 months could lead to a decrease in erectile problems.
Another 2018 study examined physical fitness and testosterone levels in 87 men with ED. Researchers found that testosterone levels were negatively correlated with levels of body fat and abdominal fat. This suggests that exercise may increase testosterone in addition to reducing body fat.
Before you start a new exercise plan, always discuss it with your doctor. This is particularly important for people with heart disease or another underlying condition that could be aggravated by vigorous activity. Learn more about exercise and ED.
Yoga can help to relax your mind and body. Since stress or anxiety can cause or contribute to ED, practicing yoga may be an effective way to ease ED symptoms.
In fact, an older 2010 study of 65 men between 24 and 60 years old found that sexual function increased significantly after a 12-week program of yoga sessions. Discover five yoga poses that could help with ED.
Erectile dysfunction foods
ED is often related to problems with blood flow. Maintaining your blood vessel health may be beneficial in both preventing and treating ED. You can achieve this by making certain lifestyle choices, such as eating a healthy diet.
Erectile dysfunction natural treatments
For some people, natural remedies may help treat ED.
Herbs and supplements
- dehydroepiandrosterone (DHEA)
- ginseng, such as Korean red ginseng
Keep in mind
Don’t buy herbs and supplements for ED treatment unless you speak with your doctor first. Many aren’t regulated by the Food and Drug Administration (FDA), which means they might contain additional ingredients not listed on their labels.
Additionally, some supplements, such as yohimbe, are associated with potentially dangerous side effects.
Your doctor may be able to recommend reputable brands as well. Avoid purchasing products online, unless your doctor confirms that they’re safe. Get more expert advice on herbs for ED.
Acupuncture is a type of traditional Chinese medicine in which needles are inserted into the skin at specific locations or acupoints. Acupuncture is believed to work through nerve stimulation, which then has an effect on the release of neurotransmitters.
It’s unclear how acupuncture works to treat ED. Studies on its effectiveness are limited, and the ones that do exist are often inconclusive. Some evidence from a 2019 review indicates that acupuncture may help to treat psychological ED.
When choosing an acupuncturist, look for a certified practitioner who uses disposable needles and follows FDA guidelines for needle disposal and sterilization. Learn more about the use of acupuncture in treating ED.
The bottom line
Multiple options exist for people looking for natural ways to treat their ED. Try one of the options above or even a combination of them. You can even pair remedies like acupuncture with Viagra and other traditional medications. Find out more about the effect of lifestyle changes on ED.
In cases where medications aren’t effective, your doctor may recommend surgical treatment. There are two types of procedures that may be used: implants and vascular surgery.
A surgeon can place a penile implant, also referred to as a prosthesis, in the penis.
There are two different types. An inflatable implant allows you to use a pump to make your penis larger, while a malleable implant allows you to adjust the position of your penis manually.
Penile implants are typically reserved for severe ED that has been unresponsive to traditional ED treatments.
Vascular surgery repairs arteries that may be blocked. This type of surgery is rare, and usually only reserved for people with pelvic trauma that leads to vascular injury.
This type of surgery can help to restore adequate blood flow to the penis. Younger people are typically better candidates for this type of procedure.
Every surgery has its benefits and drawbacks. Be sure to discuss these with your doctor if you decide to undergo surgery for ED.
ED and diabetes can occur together. In fact, according to a 2014 review, the risk of developing ED is
Diabetes affects how your body processes glucose. When your body doesn’t store glucose correctly, excess glucose can be found in your blood, leading to high blood sugar. There are two major types of diabetes: type 1 diabetes and type 2 diabetes.
Having high amounts of sugar in your blood can lead to damage to the blood vessels and nerves. This damage can also affect the blood vessels and nerves located around the penis, leading to difficulties getting or maintaining an erection.
You can take several steps to help prevent ED. Many of these steps involve making healthy lifestyle changes. Therefore, they’re not only good for preventing ED, but also for improving your overall health.
Follow the advice below to help prevent ED:
- Manage medical conditions, such as heart disease and diabetes.
- Make sure you get regular exercise.
- Maintain a moderate weight.
- Focus on eating a healthy diet.
- Find ways to reduce or manage stress.
- Try to maintain a regular sleep schedule.
- Get help if you’re experiencing anxiety or depression.
- Consider meeting with a psychotherapist to discuss your concerns.
- Quit smoking if you smoke.
- Only use alcohol in moderation.
- Avoid using drugs that haven’t been recommended by your doctor.
Also, be sure to keep up with your regular checkups. Your doctor will monitor important clinical measurements, such as your blood pressure and cholesterol levels. This can help with the early identification and treatment of conditions that can potentially lead to ED. Find out more ways to prevent ED.
If you are experiencing ED, it can be difficult to talk about it openly with your partner. However, ED is actually more common than you might think. Consider talking with your doctor so they can more accurately diagnose your symptoms.
It’s not uncommon to lose an erection from time to time, especially during periods of increased stress or sudden changes to your diet or lifestyle. But if you are unable to have or keep an erection frequently over the period of a few weeks, it is worth contacting your doctor.
In some cases, your symptoms may not actually be stemming from ED but could be symptoms of another medical condition. Your doctor can run a series of tests and evaluations to screen for those medical conditions and ultimately rule them out as potential causes.
The symptoms of ED can be very frustrating and even embarrassing at times, but many resources are available that can help. If you are concerned that you may be experiencing ED, reach out to your doctor to frankly and honestly discuss your options.
What causes erectile dysfunction?
There are many common causes of erectile dysfunction. Some of them may include:
- existing health conditions
- drug use
- alcohol use
- relationship issues
- increased age
How do I know whether my erectile dysfunction is physical or mental?
If your doctor diagnoses erectile dysfunction, they will also examine you to find out the root cause. Likely, they’ll give you a physical exam where they’ll check your vitals, as well as your genitals.
They may also give a psychological exam, where they’ll ask you questions about your health history, including your sexual and mental health.
The results of these exams will help determine whether your erectile dysfunction is physical or mental.
Can I combine erectile dysfunction treatments?
Your specific treatment plan will depend on the causes of your ED, and treatment options will be decided by your doctor.
Treatments may include a combination of medications, therapy, or devices, and you may need to try different treatment options before finding one that works.
In many cases, you can improve your ED symptoms. Many medications and treatments are available. Certain devices, such as vacuum pumps, can also help you temporarily manage your symptoms so that you can continue to engage in sexual intercourse.
Your treatment plan will depend on a variety of factors, including the severity of your ED and whether it’s caused by a specific health condition. Your doctor will work closely with you to explain the benefits and risks associated with each type of treatment.
It’s important to remember that ED is a common condition. If you’re experiencing symptoms of ED, discuss them with your doctor as soon as possible. That way, they can rule out underlying causes and begin a treatment plan.